Stockport Skin Advice and Guidance and Referral platform

A skin referral software platform pilot for advice & guidance started in 2016 and allows all general practitioners across Stockport access through their GP clinical software systems to make referrals with secure images, including dermatoscopic ones into dermatological and surgical services capable of managing the problematic skin lesion or condition. Images are captured securely via a smartphone App which are then automatically integrated with the patient referral record. The pilot has made only slow progress despite 70% of referrals being changed away from face to face consultations to advice and guidance only. The current pandemic has made no difference to the adoption of this approach which the current eRS system cannot replicate.

Benefits

• Significant reduction in outpatient appointments
• Tele-dermatology to support primary care education, improve the triage of referrals and to provide better access to specialist opinion
• Supports triage and referral management – to facilitate patients being streamed into the right service

From the practices piloted in phase 1:

• Of these, 71% were defected back to primary care with appropriate advice and guidance given. 
• Nearly all referrals to consultants (99%) for advice and guidance were responded to in the same day (compared to a three or four month waiting list for a face-to-face outpatient appointment).
• GPs supplied good-quality images – only 12% of referrals were rejected due to inadequate images even in the initial pilot period.
  • 9% reduction in primary care referrals for first outpatient appointment in pilot practices, compared to a 4% increase in non-pilot practices.

Feedback from phase 1

“Just brilliant. Quick advice back. Have managed to defer four referrals so far from my GP practice by managing in primary care, advice given via teledermatology”. GP, Stockport.

“It’s working really well. There are situations where I’m not sure what the diagnosis is or others where I’ve tried a few treatments and it’s not working – in my experience, it has stopped referrals going to outpatient departments, which is great for me and my patients. They don’t have to wait several months for an appointment and the hassle of going to hospital.” GP, Stockport.

“The teledermatology system has proved very easy to use and we have been able to give GPs advice, often avoiding hospital appointments.” Dermatologist, Stockport.

“Our GPs say that the system has altered their referral behaviour to secondary care services, as they are using more in-house skills and then using this as a secondary care opinion. It is also excellent in cases where the patient is really suffering (with an uncomfortable rash, etc.) You can get advice within hours rather than the patient waiting for weeks.” Commissioner, Stockport.

The system has now been scaled up and rolled out across other regions in Greater Manchester, with patients now able to submit images into GP practices using the smartphone App, thus avoiding the need to attend the GP practice in person